P1125 - Successful Closure of a Gastro-Bronchial Fistula Using the Over-the-Scope Clip

Swati Mahapatra, DO¹, Shivangini Duggal, MD², Monica Botros, MD¹, Gian Galura, MD¹, Sherif E.. Elhanafi, MD^1
1Texas Tech University Health Sciences Center, El Paso, TX; ²TTUHSC, El Paso, TX

Introduction: A Gastro-Bronchial Fistula (GBF) is a rare condition that commonly results from trauma, malignant infiltration, abscess formation, or post-surgical complication. A patent fistula can result in serious complications like recurrent pneumonia and bronchial abscess. Repair of GBF could be challenging and usually requires surgical intervention. We report a case of recurrent gastro-bronchial fistula which was successfully repaired endoscopically.

Case Description/Methods: A 51-year-old female with a history of left diaphragmatic hernia repair complicated by a left subdiaphragmatic abscess, left lung empyema with decortication, and history of ruptured gastric fundal diverticulum which was initially repaired with endoscopic clips and suture at an outside facility. However, few months later, the patient presented with a recurrent peri-splenic abscess and was found to have a patent GBF. Upper GI series confirmed an extraluminal pooling of contrast from the gastric fundus into a left lower lobe bronchus through a tract along the diaphragm. Endoscopic gastroduodenoscopy was performed which demonstrated remnants of previous endoscopic sutures and a 10mm sized defect in the gastric fundus. A 12mm over-the-scope clip (OTSC) was placed, and the defect was closed successfully. Follow-up esophagogram confirmed complete closure of the defect. Patient was discharged home on antibiotics with significant improvement of pulmonary symptoms.

Discussion: The cornerstone of the management of GBFs is closure to prevent further spillage of the gastric contents to the lungs. Traditionally, surgical intervention was the first line of treatment however, the evolution of advanced endoscopic closure devices has changed the paradigm of management for this complex condition. This case highlights the feasibility of successful endoscopic closure using OTSC as the first line treatment modality for gastric perforations and/or fistulas.



Disclosures:


Swati Mahapatra, DO¹, Shivangini Duggal, MD², Monica Botros, MD¹, Gian Galura, MD¹, Sherif E.. Elhanafi, MD¹. P1125 - Successful Closure of a Gastro-Bronchial Fistula Using the Over-the-Scope Clip, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.